DESCRIPTION: The proposed four-year project involves a one-year observational study of special care units (SCUs) for patients with Alzheimer's Disease and related disorders (AD). Because residential alternative settings (RASs) have been increasing rapidly as an alternative to nursing home (NH) care and because they are largely unstudied, the proposed project will compare costs and outcomes of care across three settings: 1) nursing home (NH) SCUs, 2) small (s 10 patients) RAS SCUs, and 3) large RAS SCUs. The specific aims of the proposed project are as follows: 1) To describe and compare the residents, structural characteristics, and process of care in AD SCUs in NHs and in large and small RASs, and to determine the prevalence of SCUs in these settings; 2) To compare the outcomes of SCU residents with moderate or severe cognitive impairment in NHs with those in RASs with respect to rates of avoidable hospitalizations, declines in ADLs, weight loss, change in agitated behaviors, family satisfaction, engagement in social activities, and use of physical restraints; 3) To compare the costs per resident of AD SCUs in NHs with AD SCUs in RASs; and 4) Within RASs, to determine whether the outcomes and costs of SCUs in small homes differ from those of large homes. Homes will be selected randomly from a sampling frame consisting of 5 pairs of states chosen because they represent a broad range of geography and degree of RAS regulation. Four hundred eighty subjects with dementia from 40 NH SCUs will be compared to similar numbers of patients in 40 large RAS SCUs and 60 small RAS SCUs. Assuming a 20% attrition over a one year period, this will result in an analysis sample of 1200 subjects who will have been followed for a one-year period. Power calculations using estimates from the literature as well as ongoing studies by Dr. Sloane indicate that the study will have adequate power for both facility and patient level analyses. Data collection will include facility level, patient level, and family level data and will be collected using face-to-face interviews, telephone interviews, and direct observation, with facility staff, patients, and family members. Data collection instruments and procedures developed for the NIA SCU Cooperative Agreement studies will be modified for use in the proposed project. In addition, HCFA Medicare data will be obtained for cost analyses. Data analysis will be both descriptive and analytic and will be conducted at the facility level as well as at the patient level, accounting for the clustering effect of patients within a facility.